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The procedure described by CPT® Code 29365 involves the application of a cylinder cast, commonly referred to as a stovepipe cast, which extends from the thigh down to the ankle. This type of cast is specifically utilized for the immobilization of fractures, particularly those affecting the patella (kneecap) and certain fractures located in the distal femur (the lower part of the thigh bone). The casting process begins with the application of a stockinette, which serves as a protective layer over the skin in the area designated for casting. Following the stockinette, padding is applied to provide cushioning and to enhance comfort for the patient. The next step involves the use of a plaster or fiberglass roll, which is first immersed in water to activate its setting properties. After saturation, any excess water is gently squeezed out to ensure the material is ready for application. The plaster or fiberglass is then carefully wrapped around the leg, typically starting from the distal (far) end and moving towards the proximal (near) end, ensuring that the cast conforms closely to the contours of the leg. Finally, the material is smoothed and molded to achieve a secure fit, which is essential for effective immobilization and support during the healing process.
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The application of a cylinder cast (thigh to ankle) is indicated for specific conditions and injuries that require immobilization to promote healing. The following are the primary indications for this procedure:
The procedure for applying a cylinder cast involves several detailed steps to ensure proper immobilization and support for the injured area. The following outlines the procedural steps:
After the application of the cylinder cast, post-procedure care is essential for ensuring the comfort and safety of the patient. Patients are typically advised to keep the cast dry and to avoid any activities that may put undue stress on the cast. Regular follow-up appointments may be scheduled to monitor the healing process and to make any necessary adjustments to the cast. Patients should also be educated on signs of complications, such as increased pain, swelling, or changes in skin color, which may indicate issues that require immediate medical attention.
| Short Descr | APPLICATION OF LONG LEG CAST | Medium Descr | APPLICATION CYLINDER CAST THIGH ANKLE | Long Descr | Application of cylinder cast (thigh to ankle) | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P6B - Minor procedures - musculoskeletal | MUE | 1 | CCS Clinical Classification | 214 - Traction, splints, and other wound care |
| 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | RT | Right side (used to identify procedures performed on the right side of the body) | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | KX | Requirements specified in the medical policy have been met | LT | Left side (used to identify procedures performed on the left side of the body) | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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